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   RE: When your out-of-pocket patient uses Medicaid to pay for prescriptions
 From: Justin Altschuler
 To: Member Forum
 Posted: 12-17-2017 12:02
 Message: The rules are different for medicaid and Medicare:

For Medicare, you as the provider have to “opt out,” which an affirmative step you must take. A quick google search for "Medicare opt-out" will reveal a wealth of resources. You can either opt-out and see medicare patients on a cash basis, or bill medicare for covered services for medicare patients. There is a lot written on this on the internet. Being a medicare provider (remaining in the program) and accepting cash from a medicare patient for services opens you up to big-time risk.

For medicaid, which is a state program, things are a bit more complicated, and less straightforward. As has been mentioned, you can have an “ORP” status, which essentially allows you to order supplies, referrals, and medications for medicaid patients, but otherwise not be involved. In California at least, there is nothing that prevents you from privately contracting for services with a medicaid patient (cash pay). However, this may vary state-to-state. In California, Medicaid does not require an opt-out, as Medicare does.

------Original Message------

I've also understood it that with my cash-only practice I'm not allowed to charge a Medicaid patient for services that are covered by Medicaid.  I have only a handful of these patients, so I've made the decision just not to charge them for their visit.  I have not had any problem ordering labs or prescribing medications for these patients.



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